Healthcare Provider Details

I. General information

NPI: 1700874526
Provider Name (Legal Business Name): CYTODIAGNOSTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 40TH ST SUITE 355
BALTIMORE MD
21211-2120
US

IV. Provider business mailing address

711 W 40TH ST
BALTIMORE MD
21211-2145
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-9710
  • Fax:
Mailing address:
  • Phone: 410-243-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number235
License Number StateMD

VIII. Authorized Official

Name: DR. JUAN SURIEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 410-243-9710